Provider Demographics
NPI:1710286711
Name:DAVIS, SAMUEL CLAYTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:CLAYTON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13353 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8441
Mailing Address - Country:US
Mailing Address - Phone:330-699-9131
Mailing Address - Fax:330-699-1091
Practice Address - Street 1:13353 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8441
Practice Address - Country:US
Practice Address - Phone:330-699-9131
Practice Address - Fax:330-699-1091
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03311800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist